Older women aged 55 and older will become 30% of the nation's direct-care workforce by 2018—up from 22% in 2008, according to a new study by PHI, the long-term care workforce development consultants.
This is not surprising because the nation's workforce is aging and PHI expects that 1.2 million direct-care workers will be women aged 55 and over by 2018.
"Older women are increasingly providing frontline services and supports for frail elders and people with disabilities to live independently and with dignity," said PHI President Steven Dawson, in a media release.
"National and state policymakers must work together to ensure that direct-care jobs, which are primarily funded through public dollars, are quality jobs that attract a stable, compassionate workforce. Without these workers, families will not be able to provide the support elders need to live independently and to continue to enjoy the relationships and activities that give their lives meaning," Dawson said.
In 2008, the median hourly wage for direct-care workers was $10.42, which is more than one-third less than $15.57, the median wage for all U.S. workers. Without competitive wages, the older women who are filling these positions today are likely to look elsewhere for employment, PHI said.
Direct-care workers, who are 90% female, tend to be older than women in the nation's overall workforce—22% of direct-care workers were age 55 and older in 2008 compared to 18% for the overall female workforce. An even larger proportion—28%—of personal and home care aides were aged 55 or older in 2008.
The PHI projections were made using data from the 2009 U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, and applying the information to the Bureau of Labor Statistics Employment Projections Program, 2008-18 National Employment Matrix.
Declining admissions has prompted HCA's Spring Branch Medical Center in Houston to cease inpatient operations by May 1, with nearly 500 employees expected to lose their jobs or transfer.
Outpatient services, including radiation oncology, imaging, and emergency care will continue, the hospital chain announced this week.
"Spring Branch Medical Center has had declining inpatient utilization for several years, but the services we are retaining there are obviously still needed and can be sustained," said Maura Walsh, HCA Gulf Coast Division president, in a media release.
Walsh said inpatient admissions have declined in the past few years and this trend is not expected to change. The vast majority of area residents are going elsewhere for inpatient care. Despite capital improvements to make Spring Branch viable, Walsh said there have been significant operational losses over the last five years. The hospital, built in 1958, is licensed for 299 beds, but is staffed for 160 beds.
"Since there has been significant utilization of these outpatient services by the community, HCA Gulf Coast Division recognizes the importance of maintaining these critical services at the campus for the more than 25,000 patients we expect to continue to serve this year," Walsh said. "By preserving these services, it will enable us to continue to serve over 40% of all of our patients in their own community."
HCA said about 40 of the hospital's 538 employees will be retained when inpatient services are shuttered. Management will work closely with the laid-off employees to find jobs at other HCA-affiliated facilities or with other employers. Job fairs and career transition seminars will also be made available, Walsh said.
Walsh said HCA will also work with Spring Branch's medical staff to ensure continuity of care for patients, and will assist physicians who want to transfer to other HCA-affiliated hospitals.
Physicians are key drivers of hospital revenues, and a single physician averages more than $1.5 million a year in net revenue for his or her affiliated hospital, a new national survey of hospital CFOs reported.
The survey by Irving, TX-based physician recruiters Merritt Hawkins asked CFOs in 114 U.S. hospitals to quantify how much revenue physicians in 17 specialties generated for their hospitals in the last 12 months, including net inpatient and outpatient revenue derived from patient referrals, tests, and procedures performed in the hospital.
Neurosurgeons topped the list. A single, full-time neurosurgeon generates an average of more than $2.8 million a year on behalf of the affiliated hospital. Other high revenue generating specialists include invasive cardiologists ($2.2 million), orthopedic surgeons ($2.1 million), general surgeons ($2.1 million), and hematologists/oncologists ($1.5 million), the survey showed.
Primary care physicians also generate substantial revenues for hospitals. A general internist brings in nearly $1.7 million a year on average for the affiliated hospital, a family physician more than $1.6 million, and a pediatrician more than $856,000, the survey showed.
Merritt Hawkins President Mark Smith said the survey demonstrates the central role that physicians play in the healthcare delivery system.
"The most powerful tool in healthcare remains the physician's pen," Smith said in a media release. "Patients are not admitted to the hospital or discharged, tests ordered, or procedures performed without a physician's signature. Hospitals depend on doctors to drive patient care, which in turns drives revenue."
Merritt Hawkins last conducted the survey in 2007, when the average annual revenue generated per physician across all specialties was nearly $1.5 million, slightly lower than the 2010 average. Smith said the revenue increase during a recession suggests that physicians continue to provide a high level of hospital-based services.
"Both the recession and declining reimbursement have prompted many physicians to seek closer relations with hospitals," Smith said. "More physicians are employed by hospitals today than they have been in the past and the interests of the two parties are more closely aligned."
Alpharma Inc. will pay $42.5 million to resolve whistleblower kickback and False Claims Act allegations for its marketing of the painkiller Kadian, the Justice Department said.
Federal prosecutors alleged that between 2000-2008 Alpharma paid healthcare providers to promote or prescribe Kadian, and made misrepresentations about the safety and efficacy of the morphine-based drug.
Alpharma was sold to Bristol, TN-based King Pharmaceuticals Inc. in November 2008. Calls Tuesday night to King Pharmaceuticals were not immediately returned.
The settlement resolves a lawsuit brought by whistleblower Debra Parks in 2006. Parks will receive $5.33 million out of the federal government's $33.6 million share of the recovery, and several states will share approximately $8.9 million.
"Healthcare decisions must be based solely upon what is best for the individual patient and not on which pharmaceutical company is paying the doctor the biggest kickback," said Rod J. Rosenstein, the US Attorney in Maryland, in a media release.
The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $3 billion, according to the department.
The American Medical Association today launched the National Managed Care Contract, an online database that the physicians' association said will help its members negotiate better contracts with managed care organizations.
"The concentrated market power of large health insurers gives them an unprecedented advantage in dictating key aspects of healthcare to physicians," said AMA President J. James Rohack, MD, in a media release. "The AMA's new resources will be a welcome guide for negotiating fair contracts with health plans angling for an even greater advantage over physicians."
NMCC is the first managed care contracting resource designed specifically for physicians, and it is expected to provide model contract language that complies with the managed care laws of all 50 states and the District of Columbia, and to cover the range of physician concerns with managed care contracts, AMA said.
The searchable database associated with NMCC provides physicians with access to updated laws and regulations across the nation. It covers the managed care contracting process, the managed care contract itself, and the business relationship between physicians and health plans after an agreement has been signed, AMA said.
The NMCC database also allows physicians to:
Provide alternative language to support contract negotiations with health plans.
Ensure managed care contracts and insurers comply with state legal requirements.
Clarify key contract issues and manage ongoing relationships with health plans.
Assist with legislative, regulatory, and legal efforts to reform unfair managed care business practices.
Monitor emerging state and federal legislative and regulatory trends.
An expert panel convened by the American College of Physicians says that properly designed pay-for-performance programs can strengthen physician-patient relations and improve care.
"Concerns about the conflicts between medical professionalism and pay-for-performance have been based primarily on theories about the tension between external motivation and self-interest and the internal motivation and self-restraint that characterize professional expectations," said panel member Amir Qaseem, MD, a senior medical associate with ACP, in a media release. "We believe that physicians should play a key role in defining and evaluating P4P programs that are compatible with professionalism."
The ACP-led panel's analysis appears in the March 16 issue of Annals of Internal Medicine. The panel, which included experts in clinical medicine, law, management, and health policy, met six times to examine the relationship between medical professionalism and various P4P financial incentive programs.
The panel concluded that:
A P4P incentive should be linked to specified, evidence-based measures because they can drive the delivery of care to conform to scientific evidence. Inadequately risk-adjusted measures that do not recognize the severity or complexity of a patient's condition may lead physicians to cherry pick. The evidence must be protected from inappropriate influence by nonprofessionals or others who have a direct financial interest in a particular definition or performance measure.
Transparency of quality measures and disclosure of payment incentives may enhance patient trust.
P4P programs are unlikely to foster the equitable distribution of care unless they include measures of access to care and adequate case-mix and risk-adjustment strategies. Measuring the allocation of patients among providers enables adjustment of performance rewards based on the complexity of patient socioeconomic and clinical case-mix of a provider group.
P4P programs that pay only on the basis of the top tier of performance put physicians in competition with each other. P4P programs could be designed to encourage the sharing of knowledge, scientific evidence, and information—a principle of professionalism.
Leading provider groups used the last day of a public comment period to urge CMS to scale back the proposed rule establishing meaningful use criteria for electronic health records incentive programs.
The Englewood, CO-based Medical Group Management Association asked CMS to formally request a one-year legislative extension of Stage 1 of the incentive program from Congress.
MGMA President/CEO William F. Jessee, MD, said in a 43-page letter to CMS Acting Administrator Charlene Frizzera that a failure to substantially modify the proposal would risk meeting the goals for health information technology adoption under the $21 billion stimulus package.
"The meaningful use requirements must be achievable and verifiable without creating an undue burden on eligible professionals and their administrative staff. This is especially critical in the first years of the incentive program," Jessee said.
AMA Board Member Steven J. Stack, MD, also called the Stage 1 criteria proposed by CMS "too aggressive."
"It could unreasonably punish physicians who undertake great efforts to achieve meaningful use of EHRs— only to be denied incentive payments due to overly complex and unattainable criteria," Stack said in a media release. "We are committed to EHR adoption that streamlines physician practices and helps them continue providing high-quality care to patients, but successful integration of EHRs into patient care takes time."
AMA is recommending that CMS:
Remove the "all or nothing" approach and require physicians to meet five of the 25 proposed objectives and measures instead of all 25.
Eliminate the objectives and measures that don't directly apply to EHR adoption, such as checking insurance eligibility electronically.
Revise the definition of meaningful use for certain hospital-based physicians to broaden eligibility for the federal incentive programs.
Reduce the number of quality measure reporting requirements and allow physicians to identify only three clinically relevant measures.
"Overall, the proposed reporting criteria require more flexibility," Stack said. "We'd like to see more help for physicians in identifying the data necessary for accurate reporting."
Detroit Medical Center's Children's Hospital of Michigan has established new agreements with Henry Ford West Bloomfield Hospital and Hurley Medical Center in Flint to expand pediatric surgical expertise at these two hospitals.
DMC has also established a new Children's Hospital of Michigan Specialty Center in West Bloomfield to house pediatric surgery services for patients, the hospital announced.
Over the past several years, Children's has established outpatient specialty centers in several surrounding towns.
"As the state's busiest hospital and referral center for pediatric medical and surgical specialty care, we understand how important it is to provide this care in locations and facilities that are convenient and easily accessible to area pediatricians and their patients," said Herman B. Gray, MD, president of Children's, in a media release. "Partnerships like these provide unique opportunities to efficiently and economically expand patient access, while maintaining the highest quality care for children and adolescents in surrounding communities and throughout the state."
A recent survey found that employers are frustrated that employees aren't taking advantage of their work-based wellness programs to rid themselves of unhealthy habits such as smoking and excess weight.
This frustration is understandable. The primary motive for the wellness movement, however well-intentioned, is to reduce healthcare costs, which are growing at unsustainable rates.
There is nothing wrong with looking at the bottom line, except that your business might fall into that reliably flawed expectation within the personal fitness movement that if you simply spend money, you will get good results.
Years ago, I read an essay which argued that our goal attainment processes are out of order. As best as I can recall with my graying memory, the essayist argued that the normal process of reaching a goal was: "want, work, get." In other words: "If I want to lose weight, I will exercise and eat right, and I will get the results."
Now, in the age of advertising, credit cards, and instant gratification, Americans have skewed the process into: "want, get, work." In other words: "If I want to lose weight, I will get the home gym, buy the $125 running shoes, or join the health club, and then I will lose weight."
Of course, what is left out of the second equation is the actual exercise–the work—that will result in the weight loss. We lace up the running shoes for grocery shopping. We join the health club but interest wanes. We see the guy with the six-pack abs on late-night TV. We see the five-easy-payments plans. We buy the exercise equipment, use it a few times—-or not—and tuck it under a bed. Don't believe me? Ask a fitness trainer how much health club attendance drops off –right about now—when New Year's resolutions get fuzzy. Do an eBay or Craig's List search for "Bowflex," "like new," or "still in box," and count the hits.
The evil twin of the "want, get, work" dynamic is instant gratification—best exemplified by the wonder diets that promise to shed 20 pounds in one week. The diets may work. But, the weight loss is almost always temporary. That is because the people who undertake these dramatic regimens may be prepared for short-term deprivation, but they haven't made the long-term lifestyle adjustments needed to keep the weight off.
I'm sensing that these mischievous twins have wangled their way into the boardroom. The suits in the C-Suite have listened to HR, they bought into the wellness movement as cost-effective, they built the on-site gym, they paid for the weight-loss or smoking cessation classes. So, where are the savings for the next quarterly report?
This is the tricky part. As I said earlier, the wellness movement's primary motivation is saving money. However, any employer, or employee, who embraces the wellness movement has to look at a return on investment that might not materialize in the next few quarters. Wellness is not a penny stock. It's more like a 30-year T-note. This is an evolutionary process.
After all, Americans didn't just wake up one morning and discover they were overweight, or getting older, or addicted to nicotine. These health issues are the result of years, if not decades, of unhealthy choices that people have made. To expect that an employee is going to lose 30 pounds in the next six months because you're paying half of his gym fee is not realistic.
That doesn't mean that we should give up on the wellness movement. The fact is, we are seeing progress in societal wellness. The "obesity epidemic" has flattened—not fattened—over the last 10 years.
Fewer than one in five Americans now smoke—down from more than 42% of the population in 1965. That's taken more than 40 years, and a lot of money, but I don't believe anyone would argue that the effort wasn't worth it—or that more needs to be done.
The employer-sponsored wellness movement is still quite young. As the movement matures, it will become more effective as it finds the right combination of incentives and benefits that will nudge employees to adopt healthier lifestyles. Now is not the time to get discouraged. Now is the time to take the long view.
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The Nashville, TN, Metro Council is set to consider a measure next month asking gubernatorial candidates to deliver nearly $20 million per year in federal funding for Nashville General Hospital that advocates say is being withheld by the state. The federal government reimburses Tennessee for most of the costs incurred by public hospitals to provide uncompensated healthcare to patients who are uninsured or underinsured. But most of that money doesn't make it back to care providers like Nashville General Hospital, which is facing shaky finances and an uncertain future, The Tennessean reports.
